INFECTIONS IN CANCER PTS
Table 82-1 lists the normal barriers to infection whose disruption may permit infections in immunocompromised pts, with particular relevance for the noted cancers. Infection-associated mortality rates among cancer pts have decreased as a result of an evolving approach entailing early use of empirical broad-spectrum antibiotics; empirical antifungal therapy in neutropenic pts who, after 4–7 days of antibiotic treatment, remain febrile without positive cultures; and use of antibiotics for afebrile neutropenic pts as broad-spectrum prophylaxis against infections.
|TYPE OF DEFENSE||SPECIFIC LESION||CELLS INVOLVED||ORGANISM||CANCER ASSOCIATION||DISEASE|
|Physical barrier||Breaks in skin||Skin epithelial cells||Staphylococci, streptococci||Head and neck, squamous cell carcinoma||Cellulitis, extensive skin infection|
|Emptying of fluid collections||Occlusion of orifices: ureters, bile duct, colon||Luminal epithelial cells||Gram-negative bacilli||Renal, ovarian, biliary tree, metastatic diseases of many cancers||Rapid, overwhelming bacteremia; urinary tract infection|
|Lymphatic function||Node dissection||Lymph nodes||Staphylococci, streptococci||Breast cancer surgery||Cellulitis|
|Splenic clearance of microorganisms||Splenectomy||Splenic reticuloendothelial cells||Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, Babesia, Capnocytophaga canimorsus||Hodgkin’s disease, leukemia||Rapid, overwhelming sepsis|
|Phagocytosis||Lack of granulocytes||Granulocytes (neutrophils)||Staphylococci, streptococci, enteric organisms, fungi||Acute myeloid and acute lymphocytic leukemias, hairy cell leukemia||Bacteremia|
|Humoral immunity||Lack of antibody||B cells||S. pneumoniae, H. influenzae, N. meningitidis||Chronic lymphocytic leukemia, multiple myeloma||Infections with encapsulated organisms, sinusitis, pneumonia|
|Cellular immunity||Lack of T cells||T cells and macrophages||Mycobacterium tuberculosis, Listeria, herpesviruses, fungi, intracellular parasites||Hodgkin’s disease, leukemia, T cell lymphoma||Infections with intracellular bacteria, fungi, parasites; virus reactivation|
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